Provider Demographics
NPI:1689860769
Name:SAFIUL HASAN M.D. PC
Entity Type:Organization
Organization Name:SAFIUL HASAN M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAFIUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-682-4900
Mailing Address - Street 1:4000 HIGHLAND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2167
Mailing Address - Country:US
Mailing Address - Phone:248-682-4900
Mailing Address - Fax:248-682-4909
Practice Address - Street 1:4000 HIGHLAND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2167
Practice Address - Country:US
Practice Address - Phone:248-682-4900
Practice Address - Fax:248-682-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036123174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1781235Medicaid
MI1781235Medicaid
MIP09560001Medicare PIN